Abstract: Management of pancreatic uncinate process in laparoscopic pancreaticoduodenectomy        TAN Zhi-jian*, SHEN Zhan-tao, CHEN Gui-hao, et  al. *Department of Pancreatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China 
Corresponding author: ZHONG Xiao-sheng, E-mail：gzgentle@foxmail.com
Abstract    The laparoscopic pancreatoduodenectomy (LPD) is a demanding abdominal operation that necessitates advanced surgical skills and teamwork. Because of the deep anatomical location and difficult exposure of the pancreatic uncinate process, the treatment of the uncinate process has been the difficult in LPD; complete resection of the uncinate process and mesopancreas has become the cornerstone of LPD. The LPD surgical path and technical aspects were investigated, modified, and optimized by author’s team. The middle and left posterior combined approach was used to correctly deal with the important vascular - inferior pancreaticoduodenal artery (IPDA) in situ,  to ensure safe and complete excision of the uncinate process and mesopancreas, based on the multi-angle arterial approach. This technique is adaptable to a wide range of difficult uncinate process resections and adheres to the No-touch oncologic principles.

Key words: laparoscopic pancreatoduodenectomy, artery approach, pancreatic uncinate process, total mesopancreas excision

摘要： 腹腔镜胰十二指肠切除术（LPD）是腹部高难度手术之一，对手术技巧、团队配合等要求较高。其中，因胰腺钩突部位解剖深在、暴露困难，钩突的处理为LPD的难点；钩突及胰腺系膜的完整切除，成为LPD的关键。笔者团队通过探索、改进、优化LPD手术路径和技术细节，在开展多角度动脉入路的基础上，应用中间、左后组合入路，原位精准处理关键血管—胰十二指肠下动脉（IPDA），实现钩突和胰腺系膜安全、完整切除。该技巧能适应不同难度的钩突切除，并且符合肿瘤手术学“No touch”理念。

关键词: 腹腔镜胰十二指肠切除术, 动脉入路, 钩突, 胰腺全系膜切除